0001144204-18-020661.txt : 20180416
0001144204-18-020661.hdr.sgml : 20180416
20180416142528
ACCESSION NUMBER: 0001144204-18-020661
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161221
FILED AS OF DATE: 20180416
DATE AS OF CHANGE: 20180416
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SHEFTS MARK
CENTRAL INDEX KEY: 0001270809
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37899
FILM NUMBER: 18756321
MAIL ADDRESS:
STREET 1: 160 SUMMIT AVE
CITY: MONTVALE
STATE: NJ
ZIP: 07645
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Alliance MMA, Inc.
CENTRAL INDEX KEY: 0001674227
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990]
IRS NUMBER: 475412331
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 590 MADISON AVENUE
CITY: NEW YORK
STATE: NY
ZIP: 10022
BUSINESS PHONE: 2127397825
MAIL ADDRESS:
STREET 1: 590 MADISON AVENUE
CITY: NEW YORK
STATE: NY
ZIP: 10022
4/A
1
tv491139_form4a.xml
OWNERSHIP DOCUMENT
X0306
4/A
2016-12-21
2018-01-26
0
0001674227
Alliance MMA, Inc.
AMMA
0001270809
SHEFTS MARK
C/O ALLIANCE MMA, INC.
590 MADISON AVENUE, 21ST FLOOR
NEW YORK
NY
10022
1
0
0
0
Common Stock par value $0.001
2017-08-29
4
P
0
183486
200000
A
222374
D
Common Stock par value $0.001
151389
I
See Footnote
Warrant to Purchase Common Stock
7.43
2016-12-21
4
J
0
44446
A
2017-03-02
2021-09-02
Common Stock, par value $0.001
44446
44446
D
Warrant to Purchase Common Stock
1.50
2017-08-29
4
P
0
183486
A
2018-03-01
2020-08-28
Common Stock, par value $0.001
183486
227932
D
In addition to the 222,374 shares of common stock held directly, this also includes 151,389 shares held by the Rushcap Group, Inc., of which Mr. Shefts and his spouse, Wanda Shefts, are the sole stockholders. Mr. Shefts has voting and dispositive power over the shares held by the Rushcap Group, Inc.
Warrants allocated to Network 1 Financial Securities, Inc., during the initial public offering that were allocated to Mr. Shefts in conjucntion with initial public offering, prior to Mr. Shefts becoming areporting person.
Fully vested warrants were issued in a prior reported purchase on the Form 4 filed on January 26, 2018. The warrants were issued at a rate of one warrant per one share of common stock at a unit price of $1.09 per unit.
The original Form 4, filed on January 26, 2018, is being amended by this Form 4 amendment to correct an administrative error, which misreported a purchase that occured on October 20, 2017 as a total of 183,486 shares of common stock, when in fact an equal number of warrants to purchase common stock were also included in that purchase and the correct purchase date was August 29, 2017. As a result of this administrative error, the number of derivative securites beneficially owned by the reporting person is updated in Table II.
/s/ Mark Shefts
2018-04-11